Endovascular Treatment of Giant Serpentine Aneurysm of the Middle Cerebral Artery

Gerstmann Syndrome: What is the Possible Role of Deep Brain Stimulation?

Gerstmann syndrome, characterized by a tetrad of symptoms, which are agraphia, acalculia, left-right disorientation, and finger agnosia, presents challenges in both understanding its pathophysiology and establishing effective treatment modalities. Neuroanatomical studies have highlighted the involvement of the dominant parietal lobe, particularly the inferior parietal lobule, in the development of Gerstmann syndrome. Although current treatment options are largely supportive, recent research suggests a potential role for deep brain stimulation (DBS) in managing this condition. DBS, known for its efficacy in various neurological disorders, has been hypothesized to modulate neuronal pathways associated with Gerstmann syndrome. However, clinical evidence supporting DBS in Gerstmann syndrome remains scarce, posing challenges in patient selection and ethical considerations. Future research should prioritize investigating the efficacy and safety of DBS in Gerstmann syndrome to improve patient outcomes and quality of life.

Clinical characteristics and endovascular treatment in patients with intracranial giant serpentine aneurysms

Background

Giant serpentine aneurysms (GSAs) are a rare subtype of intracranial aneurysm. Recently, GSAs have been successfully treated with endovascular parent artery occlusion with or without distal bypass. The present study retrospectively analyzed the clinical outcomes of endovascular parent artery occlusion for intracranial GSAs.

Methods

Medical records and cerebral angiograms from our endovascular center were retrospectively analyzed. Twenty-two patients with serpentine aneurysms were treated with endovascular occlusion of the parent artery at the site of the aneurysm. These patients had selective treatment. Clinical and angiographic outcomes of the patients were assessed between the 3-month to 3-year stage.

Results

The clinical manifestations of GSA included headache, hemiparesis, SAH, epilepsy, memory loss, right oculomotor palsy, and intracerebral hemorrhage. No cerebral infarction occurred. The average Glasgow Outcome Scale (GOS) score was 5. There were no clinical complications and none of the patients had recurrence after selective embolization. All of the patients recovered well, and no recurrence or rebleeding was noted at the follow-up.

Conclusions

Endovascular parent artery occlusion may be a safe and effective way to treat intracranial GSAs.

Supergiant Cavernous Carotid Aneurysm: Successful Management with Ligation of Internal Carotid Artery and STA-MCA Bypass

Supergiant cerebral aneurysm (size > 6 cm) is a rare and challenging cerebrovascular disease with few documented cases in literature. We describe a simple, safe, and effective treatment option for supergiant cavernous carotid aneurysm and discuss the proposed mechanisms for a favorable outcome.

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

OBJECTIVES

Direct microsurgical clipping for complex middle cerebral artery (MCA) aneurysms may require a long ischemic time. Sacrifice of the parent artery with trapping or endovascular coiling also may lead to ischemic stroke. We described our institutional experience with the treatment of complex MCA aneurysms using extracranial-intracranial (EC-IC) (superficial temporal artery [STA]-MCA) bypass.

MATERIALS AND METHODS

We retrospectively reviewed patients who had treatment of IC aneurysms with the assistance of STA-MCA bypass from July 2002 to December 2016. Six patients with complex MCA aneurysms were identified, and we reviewed their clinical characteristics.

RESULTS

There were three men and three women with age ranging from 27 to 59 (mean 49) years old. Image studies showed subarachnoid hemorrhage in three cases. All patients underwent STA-MCA anastomosis, and the follow-up period ranged from 2 to 116 months (mean 51.5 months). Two of the six MCA aneurysms were fusiform, two aneurysms had bizarre configurations, one was a dissecting saccular aneurysm, and one had a blister configuration. Three patients received direct vessel trapping, two patients received aneurysm clipping, and one received aneurysm coiling. The postoperative bypass patency rate was 100%. The modified Rankin scale showed good outcomes in the six patients.

CONCLUSIONS

EC-IC bypass plays an important role as a salvage procedure in the treatment of complex MCA aneurysms which have a fusiform, bizarre, or blister configuration.